Provider Demographics
NPI:1336785252
Name:GOLDEN LIFE MANOR
Entity Type:Organization
Organization Name:GOLDEN LIFE MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORENZI
Authorized Official - Middle Name:I
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-544-9167
Mailing Address - Street 1:507 S CITADELL LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4204
Mailing Address - Country:US
Mailing Address - Phone:562-544-9167
Mailing Address - Fax:714-829-4186
Practice Address - Street 1:507 S CITADELL LN
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-4204
Practice Address - Country:US
Practice Address - Phone:562-544-9167
Practice Address - Fax:714-829-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility